POS1560-HPR “MY GUT FEELING IS…”: IDENTIFYING HOW HEALTHCARE PROFESSIONALS COMMUNICATE ABOUT PAIN IN PAEDIATRIC RHEUMATOLOGY MULTI-DISCIPLINARY TEAM MEETINGS
Authors: R. Lee, J. Mcdonagh, T. Rapley, A. Farre, M. Connelly, T. Palermo, K. Toupin-April, S. Peters, L. Cordingley
Journal: Annals of the Rheumatic Diseases (2022)

Background Multi-disciplinary teams (MDTs) are common in paediatric rheumatology where UK standards of care state that all children/young people should have access to a paediatric rheumatologist, nurse, physiotherapist, occupational therapist and a psychologist. MDTs in paediatric rheumatology regularly meet for the broader purpose of discussing the assessment of and future management plans for children/young people with a range of complex conditions in which chronic pain may feature. The content of these discussions has not been previously researched. Little is known about healthcare professional to healthcare professional communication and how this may influence the care of children/young people with chronic pain. Objectives The objective of the current study was to investigate healthcare professionals communication about children and young people with chronic musculoskeletal pain during MDT meetings in paediatric rheumatology. Methods This study was a non-participant ethnographic observation of virtual and face-to-face MDT meetings in three paediatric rheumatology centres in the UK. A structured observation checklist was used to capture and organise field notes which were analysed using an inductive thematic approach amongst research team members. Interpretation of field notes was guided by discussions with healthcare professionals from each of the teams involved. Results Forty-two healthcare professionals from across the three teams participated. Ten meetings from each team ( n =30) were observed, with meetings ranging from 1-2 hours. Analysis was organised into three themes; 1) Describing the child/young person with pain : Healthcare professionals’ perceptions about personality characteristics (e.g. “He is mature”, “She is sensitive”) were frequently used to introduce a child/young person to the team. A child/young person description was always accompanied by a description of parents and perceptions about their behaviour (e.g. “Dad is very disengaged”, “Mum can shout”). 2) Interpreting the pain of the child/young person : A core component of interpretations was professional’s familiarity with the child/young person and parents (e.g., “I haven’t got a handle on them yet”). Professionals also discussed how their interpretations of pain were influenced by “gut feelings” or “vibes that something else is going on at home”. 3) Managing the child/young person with pain : Healthcare professionals discussed the need for acceptance of pain and treatment from children/young people (e.g., “She wasn’t buying into that”; “He needs to get used to it”). Setting boundaries for children/young people and parents for accessing the team also featured in discussions (e.g., “We need to re-assure them but not always be available”). Conclusion This study highlights a range of healthcare professional approaches and processes to communicating about and discussing children/young people with pain at paediatric rheumatology MDT meetings. Findings suggest that healthcare professionals in paediatric rheumatology describe, interpret and manage the child/young person presenting with pain alongside the broader psychosocial (and less frequently the biological) context. These findings will inform the content and methods of a behaviour change intervention to improve pain communication in consultations with children/young people, parents and amongst the paediatric rheumatology team of healthcare professionals in the UK. Acknowledgements The authors would like to thank the healthcare professionals for kindly taking the time to take part in this study. The views expressed herein are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the UK Department of Health. This work was supported by a Foundation Fellowship award from Versus Arthritis (Grant 22433). Aspects of this work were also supported by funding from the Centre for Epidemiology Versus Arthritis (Grant 20380) and the NIHR Manchester Biomedical Research Centre. Disclosure of Interests None declared